Provider Demographics
NPI:1003886656
Name:BERKEY, KATHLEEN S (MA, MS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:S
Last Name:BERKEY
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5060
Mailing Address - Fax:814-333-5067
Practice Address - Street 1:18201 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3757
Practice Address - Country:US
Practice Address - Phone:814-333-5060
Practice Address - Fax:814-333-5057
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001895101YP2500X
PAPS016996103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022563030003Medicaid
PA222050Medicare PIN